Anxiety Disorders Flashcards
Anxiety Disorders in Adulthood (Historical Perspective)
Neurosis:
- until 1980, anxiety disorders were classified with dissociative and somatoform disorders
- Freud focused on the difference between objective fears and neurotic anxiety
- modern views: behavioural and cognitive-behavioural + biological factors
Anxiety Disorders Etiology (Biological Factors)
Genetics:
- heritability range from 30-50%
- broad dispositional/temperamental traits (high neuroticism, behavioural inhibition)
Neuroanatomy and neurotransmitters:
- neural fear circuit: thalamus -> amygdala, areas of the hypothalamus via the mid-brain to the brain stem -> spinal cord
- GABA (inhibitory NT), norepinephrine and serotonin play a role
Anxiety Disorders Etiology (Psychosocial Factors: Behavioural)
- anxiety and fear are acquired through learning
- the two-factor model proposes that fears are acquired through classical conditioning but are maintained by operant conditioning (fears are sometimes acquired in the absence of classical conditioning)
Anxiety Disorders Etiology (Psychological Factors: Cognitive)
- emotions are influenced by the way people appraise the future, themselves, and the world:
- beliefs - helpless, vulnerable
- schemas
- information processing biases
- automatic thoughts
Anxiety Disorders Etiology (Psychological Factors: Interpersonal)
- parents who are exercising excessive control, fostering beliefs of helplessness, & failing to promote self-efficacy and independence (insecure attachment - anxious ambivalent)
Panic Disorder
- recurrent and unexpected panic attacks
- persistent concerns about the consequences or meaning of the attack or result in a significant change in behaviour to prevent panic-like sensations
Panic Attack DSM-5 Classification
- periods of intense fear or discomfort accompanied by at least four of 13 symptoms:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling, dizzy, unsteady, light-headed, or faint
9. Chills or heat sensations
10. Parenthesis (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or ‘going crazy/
13. Fear of dying
Agoraphobia
- an active, persistent avoidance of situations
- the person is concerned that he/she will not be able to escape or get help in the event of a panic attack, or other incapacitating or embarrassing symptoms (persist for 6 months or more for diagnosis)
- panic disorder and agoraphobia are assigned as separate diagnoses (they can be co-morbid or exist on their own)
Panic Disorder Etiology - A Cognitive Perspective
Alarm Theory:
- System can be activated by emotional cues, creating false alarms, and triggering panic attacks in neutral situations where there is an absence of threat
- small change in the body as ‘signal’
*Panic self-efficacy = perceived ability to cope with panic attacks, important mechanism in CBT
Panic Disorder (Diagnosis and Assessment)
Panic disorder vs other anxiety disorder:
- uncued/unexpected panic attacks VS in response to a specific situation
A multi-method assessment includes:
- interviews
- behavioural assessment called a behavioural avoidance test
- symptom induction test
Specific Phobia DSM-5 Criteria
- Marked and persistent fear and avoidance of a specific object or situation (e.g., animals, heights)
- Excessive and disproportionate fear
- Must interfere significantly with the person’s life
Five sub-types:
1. Animal phobia
2. Natural environment phobia
3. Blood-injection-injury phobia
4. Situational phobia
5. Other
Specific Phobia Etiology
Associative model:
- criticism: equipotentiality premise
Non-associative model:
- biological predisposition for acquiring certain phobias
- failure to habituate + genetic vulnerability to anxiety = specific phobias
- Disgust sensitivity (e.g. spiders, rodents)
Social Anxiety Disorder (SocAD) Description
- shyness vs. SocAD
- interpersonal disorder
- intensely afraid of social or performance situations
- fear of showing signs of anxiety or worry that they will behave in a socially inept manner
- Onset: late childhood, adolescence
- High co-morbidity (e.g., depression, substance use)
SocAD Etiology (Genetic + Biological Factors)
Genetic Factors:
- ~50%
- behavioural inhibition
- brain structures involved in fear recognition and conditioning (e.g., amygdala)
- anxious arousal and stress
- monitoring of negative affect
- dysregulation of serotonin, norepinephrine, and other neurotransmission systems during stress responses are likely associated with socially anxious behaviour
SocAD Etiology (Environmental Factors)
Environmental factors:
- being victimized (bullying, teasing) during childhood
- linked to dysregulation HPA-axis
- intrusive and overprotective parents
SocAD Etiology (Cognitive Factors)
- self-focused attention: highly-self-critical
- public self-consciousness
- dishonest self-disclosure: less authentic manner in interactions with others
Generalized Anxiety Disorder (GAD) DSM-5 Criteria
Chronic, excessive and uncontrollable worry and anxiety:
3 out of 6 symptoms -
1. Restlessness, feeling on edge
2. Being easily fatigued
3. Difficulty concentrating
4. Irritability
5. Muscle tension
6. Sleep disturbances
GAD General Risk Factors & The Role of Cognitions
Verbal aspects of worry dampen:
- uncomfortable anxious arousal
Short-term fix in GAD: Worrying reduce the anxiety symptoms
Intolerance or uncertainty:
- discomfort with ambiguity and uncertainty
- target during treatment
Obsessive Compulsive DIsorder (OCD) DSM-5 Criteria
- Obsessions are thoughts or urges that are persistent, unwanted and markedly distressing
- Compulsions are repetitive behaviours (e.g., checking) that a person performs (to reduce anxiety/distress or to prevent a feared outcome)
- Neutralizations are brief behavioural or mental acts that individuals employ in response to an intrusion, to prevent or ‘undo’ the feared situations that appear in their intrusive thought
Obsession & compulsions must be time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
OCD Two Types of Thought-Action Fusion
- The belief that “thinking is just as bad as doing it”
- Ex. thinking about harming another person is just as bad as doing it - The belief that having a particular thought about a feared situation will increase the likelihood that the situation will happen
- Ex. that a family member will die in a car crash
*Though-action fusion is a form of inflated responsibility
OCD Etiology (Neurobiological Model)
Neurobiological model:
- Basal ganglia + frontal cortex
- SSRIs- serotonin neurotransmission
OCD Etiology (Cognitive-Behavioural Model)
Cognitive-behavioural model:
- Obsessions are causes by the person’s reaction to their own intrusive thoughts
- Catastrophic misinterpretations of these thoughts
- Unhelpful efforts to control the intrusions (e.g. thought suppression)
OCD and Checking
- Poor memory?
- Low confidence in their memory
- Repeated checking lowers memory confidence, intensifies doubts and sustains repeated checking
Posttraumatic Stress Disorder (PTSD) DSM-5 Symptoms
Non-recovery in response to an event that threatened one’s life or bodily integrity
Symptoms:
- recurrent re-experiencing of the traumatic event (e.g., nightmares)
- persistent emotional or physiological arousal in response to reminders of the trauma
- maladaptive changes in thinking patterns (now seeing the world as a dangerous place) and in mood (emotional numbing)
- hyperarousal and hyper-reactivity (e.g., chronic startle, quick to anger)
*Symptoms must persist for at least 1 month
PTSD DSM-5 Diagnosis and Assessment
(A) Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) ways
(B) Presence of one (or more) of intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred
(C) Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred
(D) Negative alterations in cognitions and mood associated with the traumatic event
(E) Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred
PTSD Etiology (Pre-Event Risk Factors)
Pre-event risk factors:
- low socio-economic status, lower education and lower tested intelligence, and a childhood history of abuse
PTSD Etiology (Post-Event Risk Factors)
Post-event risk factors:
- severity of triggering event
- lack of social support
- presence of stressful experiences after the traumatic event
PTSD Etiology (Biological)
Abnormalities in brain volume (e.g., the hippocampus) and endocrine function (e.g., the stress hormone cortisol) - Pre or post-trauma?
